Table 8.

Summary of the recommendations for not using vitamin supplements to prevent cardiovascular disease (CVD) and recommendations for the consumption of products rich in omega-3 fatty acids

Indication	Class	Level of evidence
• There is no evidence that supplementation of vitamin A or beta-carotene is beneficial to the primary or secondary prevention of CVD	III	A
• Supplementations of vitamin B and folic acid are not effective to the primary or secondary prevention of CVD	III	A
• There is no evidence that supplementation of vitamin C is beneficial to CVD prevention, progression or mortality	II	A
• Supplementation of vitamin D is not recommended to CVD prevention in individuals with normal serum levels of that vitamin. Likewise, there is no evidence that supplementation in individuals with deficiency of that vitamin will prevent CVD.	III	C
• Marine omega-3 supplementation (2-4g/day) or even at higher doses should be recommended for severe hypertriglyceridemia (>500mg/dL), at risk for pancreatitis, refractory to nonpharmacological measures and drug treatment	I	A
• At least two fish-based meals per week, as part of a healthy diet, are recommended to reduce the cardiovascular risk. That is particularly recommended for high-risk individuals, such as those with previous myocardial infarction.	I	B
• Supplementation of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) is not recommendedfor individuals at risk for cardiovascular disease undergoing evidence-based preventive treatment.	III	A
• The consumption of polyunsaturated omega-3 fatty acids of vegetable origin, as part of a healthy diet, should be recommended to reduce the cardiovascular risk, although the real benefit of that recommendation is arguable and the evidence is inconclusive.	IIb	B
• Alpha-linolenic acid (ALA) supplementation is not recommended for cardiovascular disease prevention.	III	B